UNIVERSAL IPV SCREENING AT PLANNED PARENTHOOD, NYC

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UNIVERSAL IPV SCREENING AT PLANNED PARENTHOOD, NYC

• Leslie Rottenberg, LCSW
• Center Director, Margaret Sanger Center

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UNIVERSAL SCREENINGPOLICY AND PROCEDURE

• PPNYC has had an existing policy regarding IPV
  screening in its Health Centers since 2003.
• every woman, every visit
• Two questions on medical history
• Staff verbally asked client if yes on medical
  history, or if there was clinical indication
• Training for staff once a year

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POLICY AND PROCEDURE cont.

• On-site Health Center Social Workers available
  for crisis intervention, limited counseling and
  referrals to other agencies.
• Policy on referrals to Center Social Worker
  (Minors vs. Adults)
• Referral manual for other agencies and services

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Two phases of research used to Develop a
Screening Tool for IPV in Young Women

• Leslie Davidson , Niki Palmetto , Kathleen
  Jones, Vaughn Rickert, Vicki Breitbart , Jini
  Tanenhaus , Leslie Rottenberg , Tamu Aljuwani
  , Melissa Forbes , Michelle Zeitler , Cari
  Olsen , Lynne Stevens
• (Mailman School of Public Health, Columbia
  University, Planned Parenthood of NYC, Boston
  University)

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FUNDING

• Research Funded by the CDC.
• Planned Parenthood partnered with the Columbia
  University Center for the Prevention of Youth
  Violence .

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SURVEYPhase 1 of Research

• Anonymous A-CASI survey of 645 ethnically diverse
  women (15-23yr) found 46 of young women reported
  physical or sexual violence in current
  relationship
• Womens views of screening were also evaluated
  to develop the tool.

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Focus Group Results1

• Women do not want to be talked down to by a
  provider.
• Providers should ask about the relationship
  before launching into questions about violence
  (i.e., How is your relationship going?).
• Providers should not use terms violence or
  abuse, but descriptions of behaviors.
• Providers should normalize screening questions.
• Providers must be clear about limits of
  confidentiality and of intervention.

1 12 young women
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Recommendations from women who had disclosed abuse

• What would make women more likely to disclose in
  the future?
• Confidentiality assured
• Clinic environment is friendly and understanding
• Comfort with provider, harder if it is a man1
• Provider wouldnt take any action without
  patients permission

164 15-19, 26 20-24 plt07
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Screening Recommendations1 from the women
surveyed

• 87 would not mind being asked22,3
• 73 felt they could be honest
• 90 of women feel screening all women is a good
  or a very good idea2
• 74 of women would find it easier if the provider
  were a woman3

1 Whole sample of 645 women 2 Varies by violence
experience 3 Varies by age or ethnicity
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Participants views Who Should Be Asking them?

• Parents
• 90 mom
• 73 dad
• 65 stepmom
• 57 stepdad
• Professionals
• 95 health care professional
• 89 counselor or social worker
• 58 coach

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Survey Conclusions

• High prevalence rates in young women
• Many young women are exposed to several types of
  violence in their relationships, and rarely are
  they exposed to ONLY one.
• Violence affects womens contraceptive use
• Young women support being asked about IPV,
  particularly by their health care provider
• Many women who consider themselves abused are not
  disclosing IPV to their providers.

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PHASE 2 OF RESEARCHRandomized Trial of Three
IPV Screens

• 3 Screen Types
• Basic
• Healthy Relationship
• Mutual

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The Basic Screen (5 questions)

• In the Past Year (Never, Seldom, Sometimes,
  Often, Always)
• My partner is suspicious that I am unfaithful
• My partner forced me to have sex when I
• didnt want to.
• My partner hit, slapped, or physically hurt me
  on purpose
• Ever in your lifetime (Yes / No)
• Have you ever been slapped, hit, or otherwise
  physically hurt by any partner?
• Has anyone ever raped you or forced you into a
  sexual act?

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The Healthy Relationship Screen(7 Questions)

• Basic Screen PLUS
• My partner respects me
• My partner treats me well
• Responses
• Never, Seldom, Sometimes, Often, Always

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The Mutual Screen (8 questions)

• Basic Screen PLUS in the past year
• I am suspicious that my partner is unfaithful
• I forced my partner to have sex when s/he
  didnt want to
• I hit, slapped, or physically hurt my partner
  on purpose
• Responses
• Never, Seldom, Sometimes, Often, Always

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Implementing

• Screening was integrated into existing
  reproductive health care services
• Medical providers were given a series of
  extensive training sessions
• Follow-up with medical providers was done to
  gather feedback of provider experience.

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TRAINING CONTENT

• Definition of Intimate Partner Violence.
• Views and values around IPV and screening.
• Why Screen in a health care facility?
• Trial of three screens and procedures.
• Feedback of results at end of trial.

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RESEARCH TRIAL CONCLUSIONS

• All three screens performed well, and were
  significantly improved over previous practices.
• No screening approach performed better than the
  others.

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WHERE ARE WE NOW?

• Revision to medical history using data from trial
  of 3 screens
• Additional training for providers given research
  feedback
• Monitoring the process
• Yearly chart audit
• Feedback from providers and social workers